Basic Information
| Provider Information | |||||||||
| NPI: | 1992960876 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASS COUNTY MEMORIAL HOSPITAL RHC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ATLANTIC MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500221936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122432850 | ||||||||
| FaxNumber: | 7122437423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 E 10TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500221936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122432850 | ||||||||
| FaxNumber: | 7122437423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | STANGL | ||||||||
| AuthorizedOfficialFirstName: | ABBEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7122437804 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363LF0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.